支气管镜的基本操作

支气管镜的基本操作方苏榕1编辑ppt

支气管镜的适应症，禁忌症支气管镜术前的准备工作气管-支气管的解剖结构支气管镜的基本操作方法2编辑ppt支气管镜的适应症

3编辑ppt诊断方面

不明原因的咯血，慢性咳嗽，声音嘶哑，局限性哮鸣音支气管感染性疾病的病因学诊断肺炎胸片或CT检查异常已诊断肺癌术前检查，指导手术范围及估计预后食管-支气管瘘的确诊胸部外伤，怀疑有支气管裂伤和断裂4编辑ppt治疗方面取出支气管异物某些肺不张，肺脓疡等咯血治疗引导气管插管支气管镜下治疗5编辑ppt

支气管镜的禁忌症6编辑ppt

活动性大出血不能纠正的出血倾向尿毒症，活检易出血者严重肺动脉高压，活检易出血者严重心、肺功能障碍严重心律失常新近发生心肌梗死或心绞痛疑有主动脉瘤全身情况极度衰竭严重的上腔静脉阻塞综合征7编辑ppt

支气管镜术前准备8编辑ppt术前检查

了解病史、测量血压及心肺体检胸片或胸部CT检查出、凝血时间、血小板记数乙肝两对半ECG检查血气分析9编辑ppt患者准备

向患者讲明检查目的、意义、配合方法术前签字术前禁食6小时术前30分钟肌注安定和阿托品有异齿术前摘下

10编辑ppt

气管—支气管的解剖结构11编辑ppt12编辑ppt气管

上段固定于喉部，下段与主支气管相连接。气管由15－20个软骨环构成，成人气管横径18－20mm，长度10－13cm，气管分叉角度55－65°。

气管前有甲状腺，后与食道相邻。13编辑ppt主支气管

右主支气管

短而粗，平均长度25mm，直径11－15mm。左主支气管

细而长,平均长度50mm,直径9－11mm。14编辑ppt右侧叶支气管

右上叶支气管

长度9mm，直径8mm右中间段支气管

长度8－20mm，直径8mm右中叶支气管

长度10－20mm,直径7mm右下叶支气管

长度9mm,直径7mm15编辑ppt左侧叶支气管

左上叶支气管

距左上叶支气管开口约5mm处，向前下处方发出舌段。左下叶支气管

距左下叶支气管开口约5mm处，向后发出背段。16编辑ppt支气管镜操作方法

17编辑ppt18编辑ppt19编辑ppt20编辑ppt21编辑ppt支气管分支命名右肺左肺上叶B1尖段上叶上叶分支B1+2尖后段B2后段B3前段B3前段中叶B4外段舌叶B4上舌段B5内段B5下舌段下叶B6背段下叶B6背段B7内基底段B8前基底段B8前基底段B9外基底段B9外基底段B10后基底段B10后基底段22编辑pptGroup1Exercises23编辑pptStep1:nosetolarynxThescopeisadvancedfromthenosetothelarynx.Thisstepincludeslocalanesthesia24编辑pptStep2:larynxtosubglottisFromthelarynxthetracheaisenteredtothesubglotticarea.Iffromthehead:oncethevocalcordsarepassedthescopeisslightlyflexeddownwards.Iffromthefront:oncethevocalcordsarepassedthescopeisslightlyflexedupwards.25编辑pptStep3:FollowthecurvetothecarinaTheTracheaisnota“straightpipe”;Itdeviatesposteriorlyandslightlytotherightwhenapproachingthemaincarina.26编辑pptStep4a:CarinatoleftmainbronchusFromtheneutralpositiontheLMBisenteredjustbytwistingthewristtotheleftandadvancingfor1-2cm.27编辑pptStep4b:CarinatorightmainbronchusFromtheneutralpositiontheRMBisenteredjustbytwistingthewristtotherightandadvancingthescopefor1-2cm28编辑pptFromtheneutralpositiontheleftandrightmainbronchiareenteredalternativelyjustbytwistingthewristandadvancingthescopeforfewcm.Step4c:Left-right-neutral29编辑pptStep5a:Down-up-leftmainbronchusThescopeisslowlyadvancedthepulledbackuptheLMBwhilealwayskeepingitinthemiddleoftheairwaylumen.30编辑pptStep5b:Down-uprightmainbronchusThescopeisslowlyadvanceddowntheRMBtoRLLandpulledbackupwardswhilealwayskeepingitinthemiddleoftheairwaylumen.31编辑pptGroup2Exercises32编辑pptStep6a:LeftmaintoleftupperlobebronchusFromtheLMBthescopeisadvancedtotheentranceoftheLULbronchus.33编辑pptStep6b:LeftmaintoleftlowerlobebronchusThescopeisadvanceddowntheLMBtotheentranceoftheLLLbronchus.34编辑pptStep6c:RightmaintorightupperlobebronchusThescopeisadvanceddowntheRMBthenwiththewristtwisted60degreesfrommidlinethescopeisflexeduptotheentranceofRUL.35编辑pptStep6d:RightmaintobronchusintermediusFromthecarinaadvancethescopedowntheRMBtothedistalbronchusintermediusandvisualizetheentrancetoRB456andthebasalpyramid.36编辑pptStep6e:RightmaintorightlowerlobebronchusAdvancethescopefromthecarinatotheentranceoftheRLLwhilealwayskeepingitinthemidline.37编辑pptGroup3Exercises38编辑pptStep7a:LeftupperlobeunodosFromthecarina,thescopeisadvancedtoLULentrance;there,justbythumbmovement,thelingulaandupperdivisionbronchusarevisualized.39编辑pptStep7b:Leftbeforefivesix(LB456)FromtheLMB,thelingulaisentered,thenthescopeispulledbackintothedistalLMBandthescopeisadvancedintothesuperiorsegmentoftheLLL.!Wristmovementsare“inthemirror”40编辑pptStep7c:LeftB6-8,9,10WiththescopeattheLLLbronchusentrance,thesuperiorsegmentisentered,thenalternately,theantero,lateralandpostero-basalsegmentsoftheLLLareentered.41编辑pptStep7d:Rightupperlobeuno-dos-tresFromtheRMBthescopeisadvancedandflexedupintotheRULbronchuswherejustbywristandthumbmovementsthethreesegmentsarevisualized;thenthescopeiswithdrawntothemaincarina.42编辑pptStep7e:Rightbeforefivesix(RB4,5,6)Fromthedistalbronchusintermedius,theRMLandsuperiorsegmentareenteredalternatively;!Wristmovementsare“inthemirror”.43编辑pptStep7f:Rightmedialbasal(RB7)(d”Artagnan)Fromthedistalbronchusintermediusthescopeisadvancedandthemedio-basalsegmentisentered.44编辑pptStep8a:LeftlowerlobebasalpyramidFromtheentranceoftheLLLbronchusgoinandoutofthe3basalsegments,thenwithdrawthescopetothecarina.45编辑pptSte